Low Expulsion Rates Research Articles

The Effect of Post-Placental Intrauterine Contraceptive Devices on Decreasing in Uterine Fundus Height in Postpartum SC Mothers

Introduction: Contraception and family planning services are an essential part of reproductive health. Postpartum IUDs in SC postpartum have a much lower expulsion rate than vaginal delivery. Objective: to determine the effect of post-placental intrauterine devices on the decrease in fundus uteri. Methods: Using a correlational analytical research design, the research design used is a prospective cohort with a sample size of 30 for the treatment group and 30 for the control group. Result: It can be concluded that the effect 2 hours after the installation of post-placental IUD is known (p-value = 0.279), which indicates that there is no influence between the variable of post-placental IUD installation of SC delivery mothers and the decrease in fundus uteri height. The effect of post-placental IUD insertion on the decrease in fundus uteri height in SC postpartum mothers at Karanganyar Regional Hospital on day 3 shows a p-value of 0.262, and it shows that there is no influence between the variable post-placental IUD insertion of SC mothers and the decrease in fundus uteri height. On day 7, the p-value = 0.008 means that the p-value is smaller than the value of α = 0.05 (p-value < 0.05) and that there is an influence between the variable of post-placental IUD insertion of SC mothers and the decrease in fundus uteri height. Post-placental IUD is a reference for making birth control choices during the postpartum period without interfering with breast milk. Conclusion: The conclusion does not prove the hypothesis in part because the rapid effect on the decrease in TFU in SC postpartum mothers is only after 7 days from the insertion of the IUD, while at 2 hours of IUD insertion and day 3 of IUD insertion, it does not have a rapid effect on reducing TFU in SC postpartum mothers. implications for the management of maternity women who plan to postpone the next pregnancy and this research can be used as empirical evidence that a post-placental intrauterine device acceptor has the potential to increase uterine contractions and accelerate the decrease in fundus uteri height on day 7.

Evaluation of IUD Insertion During CS In 100 Patient. A Prospective Study

Background: The application of an IUD to the female after placenta delivery during a caesarean section had several benefits since the female was under anesthetic, which reduced the need for additional manipulation and pain, and the female at the time of delivery had a strong desire for family planning. IUDs placed postpartum experienced numerous disengagements, including bleeding and displacement. Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section in 100 patients. Patient and methods: A prospective study was conducted at obstetrics and gynecology department of Damanhur Medical National Institute in the period from March 2022 to March 2023. Group I: included 52 women who agreed to insert immediate post placental IUD at the cesarean delivery. Group II: included 48 women as control group. The type of IUD used was cupper-T IUD, both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients’ satisfaction. Results: In both groups, the demographic information was comparable. The medical histories of the investigated patients and the control group did not differ significantly according to our research. The study group's caesarean procedure took a little longer to complete. There were no appreciable differences between the two groups in terms of infection, puerperal hemorrhage, or IUD displacement. Both groups' satisfaction levels were displayed as either pain or displacement. In the research and control groups, the expulsion rates were 3.92% and 0.00%, respectively. Conclusion: Based on our research, we draw the conclusion that IUD insertion during CS is safe and effective, avoiding the reasons why it can be challenging to insert an IUD after puerperium and having a low expulsion rate; so, it can be considered a standard procedure.

Feasibility and Effectiveness of Hysteroscopic Suture Fixation of the Levonorgestrel-Releasing Intrauterine System in the Treatment of Adenomyosis

To evaluate the feasibility and effectiveness of hysteroscopic suture fixation of the levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of adenomyosis. A retrospective case series. Two teaching hospitals with the technology of hysteroscopic suture fixation of the LNG-IUS. The study reviewed 79 adenomyosis patients who received the hysteroscopic suture fixation of the LNG-IUS from January 2021 to May 2022. Hysteroscopic suture fixation of the LNG-IUS to the posterior uterine wall with nondissolvable suture. All patients underwent one-year postoperative follow-up to evaluate the LNG-IUS expulsion rate, postoperative efficacy, and side effects. Two patients (2.6%) experienced expulsion of the LNG-IUS at 8 months and 12 months postoperatively, respectively. The visual analog pain scale, pictorial blood loss assessment chart score and carbohydrate antigen 125 markedly decreased after the suture fixation of the LNG-IUS compared with baseline in all patients (p <.001). Hemoglobin increased significantly (p <.001). The most common side effect was irregular bleeding, which accounted for 44.3%. The second common side effect was weight gain, which accounted for 29.2%. The composite effectiveness based on pain and bleeding showed that the effective treatment rates at 1, 3, 6, and 12 months after surgery were 92.4%, 97.4%, 96.2%, and 97.4% respectively. Hysteroscopic suture fixation of the LNG-IUS to the uterine fundus was associated with low expulsion rates and significantly improved dysmenorrhea and bleeding.

Clinical Outcomes of Post Placental Intrauterine Contraceptive Device Insertion in Women Delivering by Cesarean Section

Background: Short pregnancy interval after caesarean section increases the risks of morbidity, mortality and surgical interventions. This can be easily avoided by post placental insertion of IUCD during caesarean section. Immediate post placental IUCD insertion is defined as insertion of IUCD within 10 minutes of delivery of the placenta. It is a very promising an appealing approach as patient does not have to come for a separate postpartum visit. Objectives: To determine the outcome (safety, complications, failure and continuation rate) of post placental IUCD insertion during caesarean section. Materials and Methods: Our study was a prospective cross-sectional study, carried out in the Department of Obstetrics and gynecology at Qazi Hussain Ahmad Medical Complex, Nowshera. All the pregnant women willing for post placental intrauterine contraceptive device were included in the study. Women who had postpartum hemorrhage, chorioamnionitis, structurally malformed uterus and fibroid uterus were excluded from the study. Follow up visits were scheduled at one month, 3 months and 6 months. Results: 156 women were included in this study. Majority(35.2%) belonged to 31- 35 years age group. 46.7% of them were illiterate and 30.7% have just primary education. 40.38% of women belonged to low socio-economic group. 26.2% of women were para 4. 26.9% had previous 3 caesarean section. The most common adverse events during follow up of 6months were vaginal discharge, menstrual irregularities and pelvic pain. At the end of 6 months there were 9expulsions, 12 removals and 2 pregnancies with the gross cumulative expulsions, removal, failure and continuation rate of 5.7%, 7.6%, 1.28% and 85.2% respectively. The incidence of undescended strings at the end of 6 months was high (32.4%). Conclusion: Post placental intra uterine Copper T 380 A insertion is a safe, effective and easy reversible method of contraception with low expulsion and high continuation rates. Keywords: Intrauterine device,Intra-cesarean section, Post placental insertion

POSTPARTUM INSERTION OF INTRAUTERINE CONTRACEPTIVE DEVICE: A SAFE AND EFFECTIVE CONTRACEPTION

The incidence of maternal mortality and morbidity related to the termination of unwanted pregnancy in Pakistan is rising at an alarming rate. Instant Postpartum insertion of intrauterine contraceptive device (PPIUCD) is an effective contraceptive measure to reduce unexpected pregnancy and its associated complications in developing countries like Pakistan. The current study was conducted in a public sector hospital in Karachi with a total of 7314 pregnant women counselled for insertion of PPIUCD antenatally. Out of which 5682 women agreed to the insertion and 1632 refused the procedure, mostly due to unfamiliarity with PPIUCD insertion. PPIUCD was inserted within 48 hours of delivery in 1441 patients and they were followed for 6 months onwards. Total postpartum insertions were 1441 which was found to be an effective measure with the continuation rate of 91% among 785 followed up cases. Postpartum IUCD insertion was found as an effective, satisfactory and convenient practice for the women of developing countries like Pakistan, to get an on-time appropriate contraceptive measure. : PPIUCD was found to have high retention and low expulsion rate and its efficacy can be improved further by proper training and skills of healthcare professionals. In this regard, appropriate strategies should be formulated and implemented at the statutory level by increasing social awareness and practice of using PPIUCD by health care providers to reduce undesired pregnancies.

Risk factors for postpartum intrauterine device expulsion among women delivering at a tertiary Hospital in Uganda: a prospective cohort study

BackgroundPostpartum intrauterine device (PPIUD) use refers to intrauterine device (IUD) insertion after delivery but within 48 h of birth. In Uganda, the general use of modern methods of contraception is low with < 1% of the women adopting the IUD as a method of contraception. An important limiting factor to increased uptake of immediate postpartum IUD insertion may be its expulsion rates which vary widely. There is minimal documentation PPIUD expulsion rates and factors associated with PPIUD expulsion during puerperium in Uganda.ObjectiveWe aimed to determine the proportion of TCu380A (copper) intrauterine devices expelled by 6 weeks postpartum, and identify risk factors for expulsion among women delivering at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.MethodsWe conducted a prospective cohort study from September 1, 2014 to January 31, 2015 at MRRH. We administered a structured questionnaire to all participants, to capture data on their baseline demographic, clinical and obstetric characteristics. We followed up women who accepted the PPIUD insertions at 6 weeks post insertion for any IUD expulsion. We fit multivariable log binomial regression models to identify risk factors for IUD expulsion.ResultsWe enrolled 167 women who had PPIUDs inserted. Of the144 women who returned at 6 weeks for follow up, 13 (9%; 95%CI:4.9–15%) of them had the IUDs expelled. In the multivariable model, the significant risk factors for PPIUD expulsion were: IUD insertion more than 10 min post-delivery (aRR 8.1, 95%CI 1.26–51.98, p = 0.027) and bloody lochia flow of ≥15 days (aRR 8.5, 95%CI 1.47–48.47, p = 0.017).ConclusionThe cumulative expulsion rate of postpartum IUDs among women delivering at MRRH was low and comparable to expulsion rates in interval insertions. Longer duration from delivery to IUD insertions and longer duration of bloody lochia flow were key risk factors for postpartum IUD expulsion. More emphasis should be put on prenatal counseling for postpartum family planning to allow for postplacental IUD insertions, which are associated with lower expulsion rates.

Indications and reasons for discontinuing the levonorgestrel-releasing intrauterine system (LNG-IUS)

Abstract Objectives: to identify the main indications and reasons for discontinuing the use of the Levonorgestrel-Releasing Intrauterine System (LNG-IUS). Methods: a cross-sectional study was carried out from medical records of 327 women who used the LNG-IUS 52mg between January 2011 and December 2016 at a public hospital in the Northeast of Brazil. Results: the main indications for the use of the LNG-IUS were: contraception (32.7%), myoma/metrorrhagia (28.7%) and endometriosis/pelvic pain (22.3%). Of the 327 women, 68 (20.8%) had discontinued using the device. The most frequent reasons for discontinuation were: expulsion (9.2%), LNG-IUS expiration (3.7%), bleeding (2.4%) and pain (1.5%). Most patients had no difficulty in the insertion and did not require anesthesia/sedation. Among the 30 women who expelled the device, 17 (56.7%) had used it for metrorrhagia and myoma, 8 (26.7%) for contraception, and 5 (16.6%) for endometriosis/pelvic pain. Conclusions: the LNG-IUS is a well-accepted contraceptive method, with therapeutic applications for some gynecological conditions and a low expulsion rate.

Medical Expulsive Therapy (MET) for Large Distal Ureteral Stones: A Prospective Study Comparing Three Drugs

Introduction: One of the most common disorders of the urinary tract is Urolithiasis. Twenty percent of lithiasis are located in the ureter of which 68% are seen in the distal ureter. The concept of medical expulsive therapy (MET) has been developed with enough knowledge of the ureter physiology in order to make easier the spontaneous expulsion of the stone. The aim of this study was to evaluate the efficacy and safety of three different drugs for the treatment of pelvic ureteral stones. Materiel and Methods: Between October 2017 and November 2018, 90 adult patients presenting with low or non-obstructive pelvic ureteral stones sized 8 to 10 mm were included. They were prospectively randomized, using computer-based randomization charts, into three equal groups: treatment with ketoprofen 100 mg once daily (Group I), silodosin 8 mg once daily (Group II) and tadalafil 5 mg once daily (Group III). The aim was to compare spontaneous expulsion of stone between those drugs Results: The mean expulsion time from the start of MET was 11.5 ± 3.27 days for ketoprofen group, 10.71 ± 3.98 days for silodosin group and 10.57 ± 3.40 days for tadalafil group. But these differences were also not significant (P = 0.79). The use of analgesics (grade II) was higher in groups II and III compared to group I, but without significant difference (23.33% in group I, 33.33% in group II and 40% in group III, p = 0.38). Discussion: The overall chance of spontaneous passage is low when the stone diameter is sized more than 7 mm. A wide range of spontaneous passage rates have been reported in the literature, varying from 71% to 98% for distal ureteral stones less than 5 mm and 25% - 53% for stone sized 5 to 10 mm with a mean expulsion time of more than 10 days. Conclusion: The three drugs have a low expulsion rate for 8, 9 and 10 mm pelvic ureteral stones with a higher adverse event rate for the NSAID group.

Determinants for Utilization of Post-Partum Intra-Uterine Contraceptive Device: A Cross-Sectional Study

Background: India ranks second in terms of population in the world. Sehore district of Madhya Pradesh has total fertility rate more than or equal to 3.0 and is a Mission ParivarVikas district.Objectives:This study assesses the level of satisfaction amongst the acceptors of Post-Partum Intra Uterine Contraceptive Device (PPIUCD), identify the reasons for removal of PPIUCD, assesses the quality of PPIUCD related counselling given to Antenatal women.Methods: A cross-sectional study was conducted between February to July 2018. The sample included 255 beneficiaries of PPIUCD. Only those women who got PPIUCD inserted before six months were part of the study. In addition, 30 counselling session were assessed to evaluate the quality of counselling.Results: Higher acceptance for PPIUCD was seen among primiparous, expulsion was reported in 10.98% of the cases, abdominal pain was a complaint in 12.94% and bleeding in 21.96% of the women. Majority stated bleeding issues as the reason for removal. Gaps observed during counselling werefailure to offer basket of choices, non-involvement of partner or family member emphasizing the advantages and failure to inform about the limitations and side effects of PPIUCD.Conclusion: Government is taking many efforts in bringing down the TFR. With such low expulsion rates, PPIUCD can be the solution for the countries facing population crises. It can help bring down the high maternal and neonatal mortality.Acceptance for PPIUCD can be improved by counselling the women during antenatal period through dedicated family planning counsellors.

Intrauterine Contraceptive Device Insertion during Cesarean Section versus Conventional Application: A Randomized Clinical Trial

Objective: To compare immediate intrauterine contraceptive device (IUCD) (Copper T 380A) insertion (within 10 minutes of placenta delivery) after caesarean section versus conventional application. Method: The study involved 200 women who were booked for elective cesarean section and wanted IUCD insertion in Department of obstetrics and gynecology, Beni Suef University Hospital, Egypt. Participants were randomly assigned for IUCD insertion at the time of cesarean delivery or 6 weeks postpartum. The primary outcome was IUCD expulsion rate. Results: Follow-up of women within 6 months of IUCD application showed that expulsion rate was 10/94 (10.6%) in immediate group but 4/95 (4.2%) in conventional group with no statistical significance between the studied groups. Pelvic infection rate was 2.3% and 2.2% respectively, a difference that was not statistically significant. Also there was no significant difference in bleeding patterns along the 6 weeks follow up. Continuation rate was 75/94 (83%) in immediate group and 83/95 (87.4%) in conventional group. Device tail visibility at 1 week, 6 weeks and 6 months postpartum was significantly lower in immediate group than conventional group (p value <0.0001). Conclusion: Insertion of Copper T 380A IUD during C-section is safe and effective with expected low expulsion, and high continuation rate as in conventional method. Clinical trial registry: clinicaltrials.gov NCT02674139. Synopsis: Insertion of Copper T 380A during C-section is safe and effective with expected low expulsion, high satisfaction and continuation rates. It should be offered to mothers planned for elective cesarean.

Modification of Immediate Postplacenta CuT-380A IUD Insertion Using Ring Forceps and Standard Inserter: Twelve Months Follow-up

Objective: To evaluate the outcome of CuT-380A IUD postplacental&#x0D; insertion in vaginal delivery using new modification insertion technique.&#x0D; &#x0D; Method: We carried out a prospective cohort study of postplacental&#x0D; IUD insertion by means of ’push and push’ technique, using ring forceps and standard inserter (inserter tube and plunger rod). We included women who underwent vaginal delivery from 1st June 2009&#x0D; until 31st March 2011 and had postplacental IUD insertion. Followup&#x0D; was conducted for 12 months, including history, physical examination, ultrasound and questionnaires during evaluation, through home visits and by phone. The first monitoring is before 6 weeks after delivery, the second monitoring was after 6 weeks up to 3&#x0D; months, the third is after 3 months up to 6 months, the fourth is after 6 months up to 12 months, the fifth is after 12 months up to 24 months and the sixth is after 24 months up to 32 months after insertion.&#x0D; &#x0D; Result: On the second monitoring, 2 acceptors experienced expulsion.&#x0D; At the third monitoring period, one acceptor requested for IUD&#x0D; removal. At 9 months up to 12 months post-insertion, one expulsion&#x0D; was encountered, and one acceptor requested removal of device. At&#x0D; ≥12 months there was one acceptor who had IUD removal. We did&#x0D; not find any report of unintended pregnancy or perforation.&#x0D; &#x0D; Conclusion: Immediate post-placental insertion of CuT-380A IUD&#x0D; after vaginal delivery using ’push and push’ technique is safe and effective.&#x0D; The pregnancy rate at typical use is 0%, continuation rate is&#x0D; 94.1% and low expulsion rate (2.86%). Loss of follow up was 5.6%&#x0D; and no perforation was reported.&#x0D; &#x0D; Keywords: continuation rate, immediate post-placental IUD insertion,&#x0D; ’push and push’ technique, typical use, vaginal delivery

Programmatic experience of post-partum IUD use in Zambia: an observational study on continuation and satisfaction

Objectives: The aim of the study was to assess continuation rates and satisfaction among post-partum intrauterine device (PPIUD) accepters.Methods: This prospective observational study comprised 591 Zambian women who underwent PPIUD insertion at sites of the Society for Family Health, Lusaka, Zambia. The women were contacted 6–12 months after PPIUD insertion and asked to return to the clinic for interview and examination. If the IUD strings were not visible, an ultrasound was performed. Participants were asked about their satisfaction with the PPIUD. Main outcome measures were short-term PPIUD continuation and reported complications according to time of insertion.Results: Of 591 women enrolled, 305 women attended the follow-up appointment for interview and examination, giving a power of 80% to estimate an expulsion rate of 10 ± 5%. The IUD was inserted within 10 min of placental delivery (post-placental insertion) in 24.3% of participants (n = 74) and within 48 h (immediate post-partum insertion) in 71.1% of participants (n = 217). The total expulsion rate was 5.6%. Expulsion rates for post-placental and immediate post-partum insertions were 10.8% and 4.1%, respectively. No significant difference in expulsion rates was found (p = 0.10). Of those with an expulsion, 76.5% (n = 13) recognised that it had occurred. There were no reported complications, and 94.1% of women reported being satisfied or very satisfied with their PPIUD (n = 287).Conclusions: Overall, expulsion rates were lower than previously reported, particularly for immediate post-partum insertions. Attention to high fundal placement at insertion is a likely explanation for the low expulsion rates. Contrary to conventional wisdom, these low expulsion rates indicate that previous notions regarding insertion timing may not be accurate. Satisfaction levels were also favourable. PPIUD can be safe, acceptable and feasible in an African setting.

Immediate Post Placental Insertion of IUD-The Challenge to Solve the Expulsion Problem

expulsion problem by modifying existing devices, such as adding absorbable sutures (Delta-T) or additional appendages. These attempts did not appear beneficial. Post placental placement of conventional IUDs during Cesarean section is associated with lower expulsion rates when compared to immediate postplacental vaginal insertion. Expulsion rates vary from around 5% at 12 months to up to 50% and even higher if partial expulsions are included in the analysis [4-6].

Comparison of three types of intrauterine device inserted immediately after artificial abortion: a multicentral randomized controlled trial

Objective To compare the safety and effectiveness of three types of intrauterine device (IUD) inserted immediately after artificial abortion. Methods A randomized controlled clinical trial was performed in 4 family planning service stations in Pudong New Area from January to December 2012. Total 1 200 eligible women were randomly assigned to receive three types of IUD: MYCu, TCu380A or G-Cu200 (n=400 in each group) immediately after vacuum aspiration. All subjects were followed up for 12 months. The cumulative rates of termination of three IUD after 12 months were analyzed with WHO LTA 2.0 life table. Results Total 1 199 subjects were followed up for 12 months with a drop-out rate of 0.08% (1/1 200). No any uterine perforation was found. During the 12 months the pregnancy rates with IUD in situ in MYCu, TCu380A and G-Cu200 groups were 0.26/100 women year, 0 and 0.52/100 women year, respectively (χ2=1.951, P≥0.2). The rates of expulsion in three groups were 0.26/100 women year, 1.84/100 women year and 2.05/100 women year, respectively(χ2=5.539, P=0.066). The remove rates related to bleeding and paining in three groups were 1.26/100 women year, 7.29/100 women year and 2.76/100 women year, respectively (χ2=21.625, P=0.001). The discontinuation rates related to IUD use in there groups were 3.25/100 women year, 9.00/100 women year and 5.50/100 women year, respectively(χ2=12.191, P=0.004). The rates of Abnormal position in three groups were 1.51/100 women year, 0 and 0.26/100 women year, respectively (χ2=8.649, P=0.014). Conclusion Three IUDs inserted immediately after vacuum aspiration are all effective. Among three IUDs, MYCu shows lower expulsion rate, lower discontinuation rate related to IUD use and higher continuous rate; but the abnormal position rate of MYCu is higher than other two types IUD. Key words: Intrauterine devices, copper; Randomized controlled trial; Abortion, induced

Clinical Outcome of Postplacental Copper T 380A Insertion in Women Delivering by Caesarean Section.

Short interconception period after caesarean section and its associated risk of increased morbidity, mortality and surgical interventions could be avoided by postplacental IUCD insertion during the procedure. Despite the safety reports on intracaesarean IUCD insertion, obstetricians are still hesitant to extend the benefit of this long acting reversible contraception to women undergoing operative delivery. To study the clinical outcome (safety, efficacy, expulsion and continuation rates) of postplacental Copper T 380A insertion in primiparous women undergoing caesarean section. This study was a prospective observational study, carried out in the Department of Obstetrics and Gynaecology, Safdarjung hospital, which is a tertiary care hospital of Northern India. Primiparous women who delivered by caesarean section over a period of six months (July 2012 to December 2012), willing for postplacental intracaesarean IUCD insertion, and willing to comply with the study protocol, were recruited for the study. All these subjects fulfilled the WHO Standard Medical Criteria for PPIUCD insertion; follow up visits were scheduled at 1, 3, 6 and 12 months. A total of 300 primiparous women underwent postpartum intracaesarean insertion of Copper T 380A. The mean age of women included in the study was 23.12 ± 2.42 years. Most common postinsertion complication observed in the immediate postoperative period was febrile morbidity (2%). Majority of women (94.33%) had hospital stay of less than 4 days. The common adverse events observed during follow-up of 12 months were menstrual complaints, excessive vaginal discharge and persistent pelvic pain. At the end of one year, there were 16 expulsions, 21 removals, and 2 pregnancies with gross cumulative expulsion, removal, failure and continuation rates of 5.33%, 7%, 0.67% and 91%, respectively. Postplacental intracaesarean Copper T 380A insertion in primiparous women is a safe and effective method of reversible contraception, with low expulsion and high continuation rates.

Denuding and centrifugation of maturing bovine oocytes alters oocyte spindle integrity and the ability of cytoplasm to support parthenogenetic and nuclear transfer embryo development

The effects of cumulus cell removal and centrifugation of maturing bovine oocytes on nuclear maturation and subsequent embryo development after parthenogenetic activation and nuclear transfer were examined. Removal of cumulus cells at 4, 8, and 15 hr after in vitro maturation (IVM) or the centrifugation of denuded oocytes had no effect on maturation rates. Oocytes treated at 0 hr of IVM had a lower expulsion rate (50%) of the first polar body (PB1). The removal of cumulus cells and centrifugation affected the pattern of spindle microtubule distribution and division of chromosomes. There were almost no spindle microtubules allocated to PB1 and the spindles were swollen in anaphase I and telophase I oocytes. Approximately 20% of PB1 oocytes contained tripolar or multipolar spindles. After activation, oocytes denuded with or without centrifugation at 8 hr of IVM resulted in the lowest rate of development (3.0%). Denuded oocytes at 4, 15, and 24 hr of IVM with centrifugation or not resulted in similar blastocyst development rates (9.6%-13.2%). However, centrifugation of oocytes denuded at the beginning of IVM resulted in lower blastocyst development rate (8.1%, P < 0.05) than the noncentrifuged oocytes (17.3%). After nuclear transfer, the blastocyst development rates of oocytes denuded and centrifuged at 0, 4, and 8 hr of IVM were not different when compared to the same patch of noncentrifuged oocytes. However, oocytes denuded and centrifuged at 15 hr of IVM resulted in lower (P < 0.05) blastocyst development rates than the noncentrifuged oocytes. The results of this study suggest that removal of cumulus cells and centrifugation of denuded oocytes affect the spindle pattern. Embryo development of denuded and centrifuged oocytes may differ depending on the time of removal of cumulus cells.

NuvaRing Contraceptive Had Low Expulsion Rates in Four Clinical Trials

NuvaRing Contraceptive Had Low Expulsion Rates in Four Clinical Trials

Survey of IUD replacing status in Sichuan, PR China

To investigate the status of copper-bearing intrauterine device (IUD) replacing inert IUD in Sichuan Province, cluster random sampling method was adopted for the survey. Questionnaires were completed and IUD were inspected through ultrasound among 12,804 subjects of 15 counties, who were inserted an IUD from 1994 to 1998. The insertion rate of copper-bearing IUD was 42.1%, in a gradually increasing trend; it was lower in mountain areas than in plain and hilly areas and increased after induced abortion and previous IUD failure. Some factors, such as lower pregnancy rate, lower expulsion rate and easy removal, etc., contributed to copper-bearing IUD use. On the other hand, other factors like longer contraception period, lower side effects and lower cost contributed to inert IUD use. The results show that the adoption of copper-bearing IUD is increasing, but those factors influencing copper-bearing IUD replacement should not be neglected.

Expulsions following 1000 GyneFix insertions

ContextThe GyneFix intra-uterine device has been used in our family planning service since 1997. One of the perceived advantages is its low expulsion rate, as reported by clinical trials.ObjectiveTo calculate...

Immediate postabortal insertion of the frameless IUD: review of current experience

Experience with the frameless Gynefix intrauterine device (IUD) for immediate postabortal insertion is growing. Reports confirm that the design characteristics of the frameless IUD (fixed, frameless and flexible) are responsible for the low expulsion, high effectiveness and high continuation rates. Insertion is easy and safe in the hands of trained providers and appears to be as reliable and effective as when inserted at interval. The results suggest that the frameless IUD may be an important new and affordable option to prevent repeat abortion.